The Division has agreed to extend the deadline for compliance with this report until 1-31-11.
Between now and 1-31-11, Claim Administrators are expected to review the Missing SA listing and provide resources to address all entries on the EDI Missing SA list. This list is cumulative; updated the first day of every month; posted in your Claims EDI R3 Trading Partner Warehouse Account; and is available to anyone from that Trading Partner who is a registered user. If you do not have access to your EDI Trading Partner Warehouse Account, please contact your company’s/TPA’s EDI representative(s) to discuss the list.
On or before 1-31-11, the Division expects that all claim administrators:
To assist Claim Administrators with this Missing SA requirement, the Division has agreed to accept a Paper DWC-13 form for any ‘legacy claim’ (Date Claim Admin’s Knowledge of Injury was prior to Claim Admin’s R3 Implementation Date) IF the claim is now closed, AND the filing is a FINAL. The FINAL legacy paper 13 must be complete and accurate. Medical, Hospital and Drugs/Supplies will not be required. All other indemnity and medical info must be accurate and greater or equal to the amounts on the previous DWC-13 filed.
If the Claim Administrator can not file an MTC 01 to Cancel claims previously filed in error and are now Medical Only, the Division will accept an email to the EDI Team (email@example.com) with an attached listing (JCN, Name and DOI) and documentation that these claims were previously filed in error and should be canceled because they are Medical Only. If the Division has any documentation of indemnity payments beyond the Initial payment reported on the FROI, they will contact the claim administrator for further clarification of the Medical Only status.
The Division’s EDI webpage has been updated to include a short PowerPoint presentation on the Missing SA process.
Failure to respond and address your Missing SA Reports will result in a referral to the Bureau of Monitoring and Audit for further action.
Please send an email to the EDI Team (firstname.lastname@example.org) if you have any questions.